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Scandal of the care of the elderly

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by Gildas the Monk on February 20, 2011

The coalition must address the scandal of the care of the elderly.

George Osborne has been right to face the challenge of the deficit promptly and robustly. The coalition inherited a deficit problem produced by years of profligacy by government of all colours, when wheeling out figures on public spending was the magic bullet for all problems, without reference to value for money or, bluntly, whether the country could afford it. Osborne cannot openly say so in case he spooks the market, but the country came close to losing the confidence of the money market. Given the state of government borrowing a higher rate of interest would have all but crippled the nation, and risked a restructuring of expenditure imposed from whoever the government would have had to turn for a bail out – as we have seen in Ireland.

But addressing the deficit in the nation’s finances is necessary, not sufficient, purpose of government. A government needs a wider moral compass, and the will and imagination to deal with critical social issues; or at least facilitate is citizens the means to do so themselves.

David Cameron has laid out his platform for a moral vision to go along with fiscal and economic re-structuring based on “the Big Society.” Cameron seems sincere, but it is hard to see this amorphous idea striking a chord with the very members of the “Big Society” which it seeks to engage, or that the concept has a cutting edge of relevance to the real, day to day concerns.

There are many issues that lay legitimate claim to the priority of government and resources; reform of the welfare sector; youth unemployment; lack of affordable housing. However, I suggest the highest moral duty of the coalition must be to address the scandal of care of the elderly, in hospitals, in care homes or indeed in their own homes.

This week Health Service ombudsman Ann Abraham presented her report to Parliament about the care of the elderly within the NHS. For once, a quango-ista has done something useful.

Here is a sample of a case study, taken at random:

“Mr D was first admitted to the Royal Bolton Hospital NHS Foundation Trust with a suspected heart attack and discharged a week later with further tests planned on an outpatient basis. Four weeks later, Mr D was readmitted with severe back and stomach pain. He was described by clinicians and nurses at the hospital as a quiet man, well-liked, who never complained or made a fuss. He did not like to bother the nursing staff.

Mr D was diagnosed with advanced stomach cancer. His discharge, originally planned for Tuesday 30 August, was brought forward to 27 August, the Saturday of a bank holiday weekend. On the day of discharge, which his daughter described as a ‘shambles’, the family arrived to find Mr D in a distressed condition behind drawn curtains in a chair. He had been waiting for several hours to go home. He was in pain, desperate to go to the toilet and unable to ask for help because he was so dehydrated he could not speak properly or swallow. His daughter told us that ‘his tongue was like a piece of dried leather’. The emergency button had been placed beyond his reach. His drip had been removed and the bag of fluid had fallen and had leaked all over the floor making his feet wet. When the family asked for help to put Mr D on the commode he had ‘squealed like a piglet’ with pain. An ambulance booked to take him home in the morning had not arrived and at 2.30pm the family decided to take him home in their car. This was achieved with great difficulty and discomfort for Mr D.

On arriving home, his family found that Mr D had not been given enough painkillers for the bank holiday weekend. He had been given two bottles of Oramorph (morphine in an oral solution), insufficient for three days, and not suitable as by this time he was unable to swallow. Consequently, the family spent much of the weekend driving round trying to get prescription forms signed, and permission for District Nurses to administer morphine in injectable form. Mr D died, three days after he was discharged, on the following Tuesday. His daughter described her extreme distress and the stress of trying to get his medication, fearing that he might die before she returned home. She also lost time she had hoped to spend with him over those last few days….

Mr D’s daughter complained to the Trust and the Healthcare Commission about very poor care while in hospital. When she still felt her concerns had not been understood she came to the Ombudsman. She described to us several incidents that had occurred during her father’s admissions. She said:

he was not helped to use a commode and fainted, soiling himself in the process

he was not properly cleaned and his clothes were not changed until she requested this the following day

the ward was dirty, including a squashed insect on the wall throughout his stay and nail clippings under the bed

he was left without access to drinking water or a clean glass

his pain was not controlled and medication was delayed by up to one and a half hours

pressure sores were allowed to develop

no check was made on his nutrition

his medical condition was not properly explained to his family”

It is shocking stuff, but it is not unexpected stuff. This is not to decry the NHS, or all that work within it. There are many good souls who work tirelessly and selflessly, but it is to point out that within hospitals and care homes, both private and state run, the problem of care for the elderly is becoming acute.

This is no surprise when the numbers of elderly persons in proportion to the population at large is increasing ageing so rapidly.

According to government figures by 2034, 23 per cent of the population is projected to be aged 65 and over compared to 18 per cent aged under 16. The fastest population increase has been in the number of those aged 85 and over, the “oldest old”. In 1984, there were around 660,000 people in the UK aged 85 and over. Since then the numbers have more than doubled reaching 1.4 million in 2009. By 2034 the number of people aged 85 and over is projected to be 2.5 times larger than in 2009, reaching 3.5 million and accounting for 5 per cent of the total population: http://www.statistics.gov.uk/cci/nugget.asp?ID=949

Clearly this has economic consequences. One might observe about the irony of all this is that the government exhorts us to drink less and smoke not at all, whilst all the time cynical actuaries of Whitehall must secretly be wishing we would all consume the heavily taxed products and drop down dead at the end of our tax yielding years.

Against the background of cuts in local authority spending the threat is to the existing standard of care homes, not more and better services.

I am not advocating that people should abdicate responsibility for their old age, but that society at large has a responsibility to allow them dignity in their treatment, and in their living standards.

The burden placed upon the younger generation acting as “carers” for sick and elderly parents can be intolerable. If and when the state or indeed a private organisation must step in to assist, it must be within a culture that is caring, compassionate, understanding and patient.

Cameron should move away from his concern for “the Big Society” and address a specific issue which is profoundly important real people. This must be the social priority of the now, not the future.

Gildas the Monk

{12 comments }

CascadianFebruary 20, 2011 at 19:34

Gildas, you seem to be advocating for yet more money to be shovelled into the NHS maw, when recent experience definitively proves that will not resolve the tragic issues you and others have described.

Reading the tragic tale of MrD is infuriating, were his condition and treatment reported after the fashion of an Abu Ghraib report there would be a national outcry by do-gooders . Somebody who is denied adequate access to toilet facilities, is denied water and made to sit for long periods in one painful position all the while being denied pain medication has been TORTURED. That this happened in an English hospital in the twenty-first century is shameful, and there are no extenuating circumstances for the staff who contributed to this. Any decent human noting these conditions would at a minimum arrange for pain relief, the poor man was treated worse than a dog. I do not subscribe to the idea that there are “many good souls working in the NHS”, I think it equally easy to claim that the soviet-style system is populated by sadists and time-servers unwilling to alleviate human suffering if it inconveniences them.

Indifference to human suffering, cannot be resolved by more money, and it certainly will not be resolved by the big society. In fact it seems the more resources made available decrease the necessary human compassion required in nursing and health care. The resolution lies in private health care, the sixty year NHS experiment has failed, other models exist including some in Scandinavian countries that allow private sector participation on a large scale.

And once again I find myself disagreeing with you when you say “The burden placed upon the younger generation acting as “carers” for sick and elderly parents can be intolerable.” Having recently dealt with my mothers four-year decline and eventual death due to Alzheimers I can say that the “burden” is indeed heavy and expensive, especially to arrange adequate 24-hour care in the later stages, but my brother and I managed to keep her out of institutional care for all but the last five months. It can be done if there is a will to do so, of course that option is not available when serious surgical care is required but returning once again to Mr.D he did not seem to receive any surgical or very little of any care from the NHS!

As to the future demands on the system as the baby boom bulge works its way through the system, one can only stare in horror. However it would seem to be good advice to NEVER enter an NHS hospital and by whatever means available acquire your own lethal dosage of medication should the need arise.

Perhaps it is time to have a serious debate about euthanasia for terminal patients, dying like a dog would be preferable to Mr. D’s fate.

Having reread this I do not wish to change a word, however my tone does seem to come across as an attack on Gildas, that was not my intent. He has provided a very valuable service highlighting a major problem and “blue-skying” some necessary resolutions. I simply differ in opinion that the NHS and many of it’s staff are worthy of saving. I also have little faith that Cameron can grasp the extent of the horror that is NHS.

Ancient and Tattered AirmanFebruary 20, 2011 at 20:07

Well said, Cascadian. I am in reasonably good health but old and increasingly world weary. When the time comes I want to be the master of my own fate. The only thing I fear is a lingering painful death when it could and should be swift and painless. Providing I do not suffer from a stroke, rendering me incapable of movement, I intend to take a concoction of substances that will put me to sleep forever. I hope that this doesn’t sound mawkish or maudlin and it is NOT a cry for help thank you very much. If I am a libertarian (as I like to think) I should be at liberty to decide for myself when to shuffle off this mortal coil.

Gildas theMonkFebruary 21, 2011 at 09:33

Dear CascadianThank you for your comments. In fact there is a legitimate point to make because I am not sure that I have made it plain whether I am arguing for more money or not. What I am really arguing for I think is a change in attitude, and simply drawing attention to what seems more and more to be a culture of willful neglect, and I don’t think that’s about money.YoursG

CascadianFebruary 21, 2011 at 18:15

You are very gracious Gildas, (as befits a man of the cloth).

I think the only disagreement between us may be (I am not certain) a willingness to believe that government-and in particular the present generation of political opportunists(all parties)- has any solutions. Let them step out of my way and allow me the freedom of personal choice, it is my life.

I firmly believe, especially for health-care that a majority of the population would be better and less-expensively served by a mixed private-public system.

Ancient and Tattered Airman-there is nothing mawkish about personal freedom, or our ability to end it! We allow too much control of our health and well-being by obvious incompetents, sadists and wastrels.

Gildas theMonkFebruary 21, 2011 at 18:50

Not at all; the article wasnt thought through well enough. I believe that a change in culture is more important than expenditure per se. Also I don’t mind money being spent as long as one gets a return on the right things for the right people. Again, we can debate the specifics but I think that you are right that much is spent by, as you say,” the incompetents, sadists and wastrels”I completely agree

One of the more curious features in recent years is that if a patient who gets an anaphylactic shock (potentially and ofter terminal) in hospital and then recovers will find that the PCT will refuse to funding testing to find the allergy or toxin involved. It seems that they are more concerned about potential liability than the fact that a former patient should die from a subsequent anaphylactic shock because they cannot find out the cause and take precautions has a much lower priority. For seem reason the PCT’s think they can get away with this one much more easily with the old.

In my experience, including 8 years as a councillor, any large public organisation spends most of its effort running itself and any useful output is purely accidental. The NHS hapens to be the largest.

As a carer I found nurses always busy at their admin and stressed, never walking the ward. Call signals were rarely answered in an acceptable time adding a persistant background noise. It is not lack of staff, it is all down to misdirected effort.

Sister Eva LongoriaFebruary 20, 2011 at 08:23

DJ Liz Kershaw writes in similar terms from personal experience in “The Sunday Times2 today under the chilling headline: “Cause of Death: the NHS”There seems be be institutional-ised neglect of the old and frail